A Simple Technique for Removing the Nuss Bar with One Stabilizer: The Lateral Approach

Abstract

The removal of the substernal bar after the Nuss operation is not always an easy and fast maneuver. Only a few different technical solutions have been described. In the original Nuss technique, the patient was lying on dorsal decubitus and rotated on the side during the procedure. The Noguchi technique avoids the rotation of the patient, but requires two incisions and straightening of the bar before pulling it out the thorax. Recently, another technique was proposed, avoiding the need of straightening the bar, but it is feasible only if two operative beds in a large operative room are available. We propose another approach for the removal of the bar: The patient is lying on the lateral decubitus, only one incision is performed, and the bar is pulled out along the thoracic wall. Twenty-one bars were removed by using the present approach without any complications. The advantages of our approach on the previous techniques are the single incision, no need of rotating the patient, straightening the bar, or having two operative beds. Our approach is not feasible when metallic stabilizers have been used on both sides, but in our experience, this was not necessary in order to stabilize the bar.

Minimization of the complications associated with bar removal after the Nuss procedure in adults

“…However, there have been successive reports of severe complications, including massive hemothorax and death [10][11][12][13][14][15][16][17][18][19]. Therefore, some physicians suggested improvements to the surgical equipment and methods used for the removal to reduce surgical complications in a recent decade [11,[17][18][19][20][21][22][23][24]. Although some recent studies have discussed the occurrence of these surgical complications, disparate results were reported in large patient cohorts [11,[18][19][20]22].…”

“…The CWIG data revealed that more than half of the physicians felt that it was easier to perform surgeries on younger patients. Some modifications of surgical skill for pectus bar removal have been described for reducing the complications [17][18][19][20][21][22][23][24]. Therefore, in this study, we aimed to assess the differences in our modifications on skill and the recent surgical data on pectus bar removal.…”

Removal of pectus bar fixed with absorbable vsmetallic stabilizers

“…Different technical solutions have been proposed [7][8][9][10][11]. Although it usually represents a simple and fast procedure, several complications have been observed, some of them severe [16].…”

“…Different techniques have also been proposed for bar removal [7][8][9][10][11]. At the time of bar removal, the dissection is sometimes a tedious and time-consuming maneuver, because of fibrous and bony tissue covering the metallic device [9] (Fig.…”

A simple method of substernal bar removal after the Nuss procedure

“…Removal of the bar in the prone position allows for simple removal with the natural curvature of the bar, bringing the bar up over the patient's back and not under the operating table, which would be required during a removal procedure in the supine position. Our earlier cases were removed in the supine or lateral position as described in Varela et al [5]. In the largest single-institution reported experience with 343 Nuss bar removals, a complication rate of only 2.4% was found with one case of bleeding from a ruptured intercostal artery [6].…”